术后辅助化疗对胸段食管鳞状细胞癌根治术后患者生存的影响  

Effect of Postoperative Adjuvant Chemotherapy on Survival of Patients with Thoracic Esophageal Squamous Cell Carcinoma After Radical Surgery

作　　者：朱金峰 李炳旭 郑志勇[1] 杨鹏宇 刘菁[1] 纪缓缓 王晓敏[1] ZHU Jinfeng;LI Bingxu;ZHENG Zhiyong;YANG Pengyu;LIU Jing;JI Yuanyuan;WANG Xiaomin(Anyang Cancer Hospital,Anyang 455000,China)

机构地区：[1]安阳市肿瘤医院,河南安阳455000

出　　处：《肿瘤学杂志》2024年第10期847-852,共6页Journal of Chinese Oncology

基　　金：河南科技攻关计划联合共建项目(LHGJ20200813,LHGJ2023-0864);安阳市攻关计划(2022C01SF054,2022C01SF026)。

摘　　要：[目的]探讨术后辅助化疗对胸段食管鳞状细胞癌根治术后患者生存的影响。[方法]纳入2014年1月至2021年12月在安阳市肿瘤医院接受根治性食管切除手术的胸段食管鳞状细胞癌患者395例,其中192例行单纯手术,203例术后行辅助化疗。采用Kaplan-Meier法计算总生存(overall survival,OS)及无病生存(disease-free survival,DFS),组间生存比较采用Log-rank法。并对Ⅲ期及以上、淋巴结阳性患者的生存情况进行分析。[结果]单纯手术组和术后辅助化疗组的5年OS率分别为57.5%和60.1%(P=0.113),5年DFS率分别为39.9%和47.6%(P=0.004)。亚组分析显示:在淋巴结阳性患者中,术后辅助化疗显著提高了患者的OS(P=0.038)和DFS(P<0.001);在Ⅲ期及以上患者中,术后辅助化疗也显著提高了患者的OS(P=0.016)和DFS(P<0.001)。多因素分析显示,术后辅助化疗是患者的独立预后有利因素(OS:HR=1.878,95%CI:1.283~2.750,P=0.001;DFS:HR=1.986,95%CI:1.472~2.680,P<0.001)。[结论]术后辅助化疗可以显著提高胸段食管鳞状细胞癌根治术后患者的DFS,且可以显著提高淋巴结阳性和Ⅲ期及以上患者的DFS和OS。[Objective]To investigate the effect of postoperative adjuvant chemotherapy on the survival of patients with thoracic esophageal squamous cell carcinoma after radical surgery.[Methods]A total of 395 patients with thoracic esophageal squamous cell carcinoma who underwent radical esophagectomy at Anyang Cancer Hospital from January 2014 to December 2021 were enrolled,including 192 patients receiving surgery alone and 203 cases receiving adjuvant chemotherapy after surgery.The overall survival(OS)and disease-free survival(DFS)were calculated with Kaplan-Meier method,and compared between the two groups with Log-rank method.The OS and DFS of patients with stageⅢor above and positive lymph nodes were analyzed.[Results]The 5-year DFS rates of surgery+chemotherapy group was longer than that of surgery alone group(47.6%vs 39.9%,P=0.004),while there was no significant difference in 5-year OS rates(60.1%vs 57.5%,P=0.113).Subgroup analysis showed that postoperative adjuvant chemotherapy significantly improved OS(P=0.038)and DFS(P<0.001)in lymph nodes positive patients,and OS(P=0.016)and DFS(P<0.001)in patients with stageⅢand above.Multivariate logistic regression analysis showed that postoperative adjuvant chemotherapy was an independent prognostic factor for esophageal squamous cell carcinoma patients(OS:HR=1.878,95%CI:1.283~2.750,P=0.001;DFS:HR=1.986,95%CI:1.472~2.680,P<0.001).[Conclusion]Postoperative adjuvant chemotherapy can significantly improve the DFS of patients with thoracic esophageal squamous cell carcinoma after radical surgery,and can significantly improve the DFS and OS of patients with lymph nodes positive and stageⅢand above.

关 键 词：食管鳞状细胞癌 术后辅助化疗 总生存率 无病生存率 

分 类 号：R735.1[医药卫生—肿瘤]